Harpp, Beatrice Vivian oq
Burial - Transit Permit NEW YORK STATE DEPARTMENT OF HEALTH I t I
Bureau of Vital Records
Name First Middle Last Sex
Beatrice Vivian Harpp Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/18/2021 85 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Chester Town Warren Street Address 1165 Pucker Street,Chester Town Warren,New York 12817
111
`p Manner of Death ❑X Natural Cause ElAccident 0 Homicide 0 Suicide ❑Undetermined ❑Pending
V Circumstances Investigation
LU Medical Certifier Name Title
Christopher Mason DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Chestertown 5652 22
❑Burial Date Cemetery,Crematory or Facility Name
12/21/2021 Pine View Crematory
❑Entombment Address
gCremation Queensbury Town,New York
ElDonation
Z• Removal Date Place Removed
and/or and/or Held
H Hold Address
O
a Date Point of
CO ❑Transportation
by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
El Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
▪ Remains are Shipped,If Other than Above
Address
CC
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/21/2021 Registrar of Vital Statistics Afine6 Conway(EkctronicalrySWtte42
(signature)
District Number 5652 Place Chestertown, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 12 i23 Place of Disposition
iW
2 (address)
W
CC CC (section) (lot number) (grave number)
rt• Name of Sexton or Person in Char of Premises nr 4.._ '"v
(plea print/
/`
W Signature Title ( 4 'INZ,
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
1
i
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
1